When Insurance Asks for Money Back — And How to Prevent It
By Barbara Griswold, LMFT (August 25, 2018)
Q: A client’s insurance paid for every session for 6 months. Then they sent me an overpayment request, asking for all the money back, saying there was other insurance that should have been billed first. What should I do, and how can I prevent this from happening again?
A: Unfortunately, in my consultations I’m hearing this question a lot lately. Plans review their past claim payments throughout the year, and will sometimes notice claims that shouldn’t have been paid. For out of network providers: health plans can even ask for money back from your clients who have been reimbursed for your services.
In this case it seems the plan believes the client is covered by two plans, and that you inadvertently billed the secondary, which should be billed only after the primary plan has processed a claim.
What should you do?
- Check with the client to see if they are covered by another insurance. It could be the insurance plan has outdated or incorrect information about the existence of a second plan.
- Contact the overpayment department of the plan you billed, tell them you are going to bill the primary plan, and ask if they can hold off recouping funds while you bill the primary. Don’t delay this call – after a few weeks if you don’t respond they will begin to deduct the amount you owe from future client payments.
- Get information about the primary insurance, and bill them for the sessions. Do this even if you don’t think the sessions will be covered — you need the Explanation of Benefits (EOB) which shows amount was paid, if any.
- Bill the secondary insurance again (the one you already billed). Submit a fresh claim and attach the EOB from the primary. Ideally, they will pay whatever the primary didn’t.
What can I do to prevent this?
- Always ask clients up front, “is it possible two insurance plans might cover you?” This is particularly important when the client gives you an insurance card where the client is not the primary subscriber on the plan – that plan will usually be secondary if the client has coverage of their own.
- If a client is covered by two plans, don’t assume which is primary. Call the plans.
- Make your informed consent stronger: Consider adding this phrase to your consent: “If you give me incomplete or inaccurate insurance information, you may be responsible for the balance if I am unable to collect in full from your insurance.”